by Tom Feeny (Programme Manager, HANSHEP) Informal providers, like ‘the poor’, have historically proven to be a largely elusive population within health and development. Confounding neat categorisation within the already blurry boundaries of the ‘private sector’, informal providers are typically the subject of sweeping generalisations whose credibility rests precariously on very basic perceptions of these individuals being simply ‘outside the institutional framework’ and therefore ‘unregulated’, ‘disorganised’ and ‘uneducated’. With donors and governments historically directing their attention primarily to stakeholders within the public system and to civil society groups, informal providers have quietly proliferated in the background – to the point that they now represent a vital source of care (and importantly, the first point of contact) for many in middle and low-income countries, especially the poor. Perhaps most significantly, they have succeeded in reaching the hard-to-reach where so many before them have failed, and are have embedded themselves within the local community fabric to the extent that their inclusion in health strategies at any level is surely now without question. However, harnessing these informal providers effectively requires us to first understand them, and through research create a more nuanced contextual picture of their contribution in order to dispel the often unhelpful myths that have arisen and still persist. Recognising this, the Centre for Health Market Innovations (which is supported by HANSHEP members) launched a research project with partners in Bangladesh, India and Nigeria to explore the characteristics of some of these informal providers, and the dynamics of their interaction with the broader health system. Focusing on Village Doctors (VDs) in Bangladesh, Rural Medical Practitioners (RMPs) in Utarrakhand and Andhra Pradesh states in India, and Patent Medicine Vendors (PMVs) in Nigeria, the researchers today presented some striking findings from these studies at the Second Global Symposium on Health Systems Research in Beijing. While the three case studies did not align on every indicator, they still revealed the following important insights:
This is just a snapshot of the findings from the research, deliberately selected because they work to dispel some of the persistent myths in circulation regarding informal providers. Fortunately, the appetite for further research into informal providers is strong (as confirmed in the lively Q&A debate that followed the presentation), underscored by the recognition that focusing on the dynamics of each local market is critical given the complex incentive, supply and demand networks of health provision that informal providers both drive and are themselves shaped by. One things is certain, informal providers represent a growing and undeniable force within the health community, and despite the refusal of some governments and others to acknowledge/engage with them, it is in all our interests - particularly the patients - to begin working more effectively with these elusive actors. This article was originally posted on the HANSHEP website and is reproduced here with their permission. |
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